Traditionally, western medicine is based on pharmacology. Drugs are selected to treat illnesses and diseases. Where an illness is chronic, the drugs treat the symptoms, and enable the patient to live as normal a life as possible.
In many cases, the patient requires treatment for a number of conditions. Indeed, this phenomenon is largely a sign of the success of western medicine, since patients are able to live a productive life despite having medical conditions that in an earlier period would have been dehabilitating if not fatal. Thus, aging patients in particular often require medicinal treatment involving a large number of drugs for multiple disorders. Sometimes this includes taking medicines to treat side-effects of other drugs prescribed. This phenomenon is sometimes referred to herein as poly-pharmacy.
There are a number of studies that have looked at unwarranted drug-drug interactions (e.g., adverse side effects, toxicity, and lack of efficacy) associated with combinations of various drugs on different populations. The amount of empirical material available is enormous, but various databases and computer programs exist to help physicians access the relevant information available and to use it in prescribing appropriate treatments to the individual patient. There are also various tools available that emulate the effect of drug interactions, such as the effect of one or more effector drugs on serum levels of concomitant drugs prescribed with the effector drug. Such tools may provide an indication of potential deviations of drugs from their expected serum levels, and aid in adjusting dosages.
Furthermore and due to their individual genetic profiles, various patients often metabolize drugs to different extents resulting in increases or decreases of the drug-serum levels in such patients. For example, some patients have a specific genetic profile that has been referred to as the “CYP2D6 poor metabolizer.” Such patients have low-activity of a metabolic enzyme that is responsible for metabolizing specific drugs including antidepressant drugs such as Citalopram, duloxetine and maprotiline. Such a patient prescribed such an antidepressant may be subject to much increased serum levels of the drug, which can cause unwarranted adverse side effects, toxicity, lack of efficacy and the like.
A number of databases have been created and software has been developed to aid in prescribing an appropriate drug regimen for a patient.
By way of example, the GENELEX™ Database provides a commercially available database that calculates the potential effects of various drug-drug interactions on blood serum levels for different patient profiles. This information may be used to optimize drug prescription.
Since 2000, GENELEX™ has offered an alternative to the “one size fits all” and “trial and error” prescribing of drugs. In Genelex′ perspective, Adverse Drug Reactions are not medical errors, but events that occur in spite of compliance with dosage recommendations. A 1998 meta-analysis of thirty-nine prospective studies in U.S. hospitals estimated that 106,000 Americans die annually from adverse drug reactions. Adverse drug events are also common (50 per 1000 person years) among ambulatory patients, particularly the elderly on multiple medications. The 38% of events classified as serious are also the most preventable.
FIRST DATABANK™ provides databases that mainly detail the clinical outcomes of drug-drug interactions and provide drug monographs.
International Patent Application Publication Number WO/05038049A2, entitled “System and Method for Optimizing Drug Therapy,” relates to determining the dosage regimen for drug/pro-drug for the individual, and involves determining the metabolic profile of the individual and calculating individualized dosages of drugs according to a pharmacokinetic model.
Systems and the use of genotyping in the individualization of therapy and/or individualization of drug dosing are provided. More specifically, a pharmacokinetic model is described for the individualization of drug therapy.
Drug-drug interactions, gene-drug interactions, side-effects, non-responsiveness and toxicity are all discussed therein to some extent. The interaction of more than two drugs is referenced in passing. The system relates to clinical data, to the differences between different ethnic populations and to how the drugs are metabolized. The system described is supported on the web and has a graphic user interface designed to make accessing atypical events easy.
International Patent Application Publication Number WO/02086663A2, entitled “Computer System for Providing Information about the Risk of an Atypical Clinical Event Based Upon Genetic Information,” describes a system for determining if a gene is associated with the atypical information.
Specifically, a computer system and method for preventing atypical clinical events related to information identified by DNA testing a person is described. The method includes receiving clinical agent information. The method also relates to determining if a gene is associated with the clinical agent information, and, if so, obtaining a genetic test result value for the associated gene of the person. The method further includes comparing the genetic test result value to a list of polymorphism values associated with an atypical clinical event, and determining whether the genetic test result value correlates to a polymorphism value on the list, and if so, outputting information about the atypical clinical event associated with the polymorphism value.
Drug-drug interactions, genetics, efficacy and toxicity are discussed. Personalized dosage and prescription are described. The system described therein includes a user friendly Graphic User Interface. Warning alerts are issued where a prescribed drug is likely to result in adverse effects.
U.S. Pat. No. 7,716,065, entitled “Method of Generating and Maintaining a Patient Medication Profile,” describes a medical information processing method for providing detailed medication information that involves obtaining medication specific data, where the medication name and physical condition are obtained from sources independent of the patient.
The publication describes methods for conveniently providing a medication profile of a patient. A medication profile report may be obtained on-line by the patient or by a registered provider. In addition to information regarding the expiration of prescriptions, the patient's compliance with the prescriber's directions for usage, and the names of medications being used by a patient, the medication profile report also provides the therapeutic classes of each medication, possible drug-drug interactions, and possible side effects.
European Patent Application Publication Number EP01936525A1, entitled “Integrated Health Management Platform,” describes a healthcare management method for a consumer, such as an employee of a company, which includes identifying the target of opportunity for the consumer according to the determined health-trajectory prediction from the multi-dimensional input data.
Apparatuses, computer media, and methods for supporting health needs of a consumer by processing input data are described. An integrated health management platform supports the management of healthcare by obtaining multi-dimensional input data for a consumer, determining a health-trajectory predictor from the multi-dimensional input data, identifying a target of opportunity for the consumer in accordance with the health-trajectory predictor, and offering the target of opportunity for the consumer. Multi-dimensional input data may include claim data, consumer behavior marketing data, self-reported data, and biometric data. A consumer may be assigned to a cluster based on the multi-dimensional input data and a characteristic of the consumer may be inferred. A cluster may be associated with a disease progression, and a target of opportunity is determined from the cluster and the disease progression. An impact of the target of opportunity may be assessed by delivering treatment to a consumer at an appropriate time. The system uses clinical medical data, published data from journals and metabolic biometric data from monitors attached to patients.
The web based system combines information from a health maintenance organization, and is a learning platform that incorporates a physician's comments, creates rules and validates them. It uses a consumer profile and lifestyle and health behavior to present information via an intuitive Graphic User Interface.
International Patent Application Publication Number WO/02089017, entitled “A Method and System for Web-Based Analysis of Drug Adverse Effects,” pertains to a computer-implemented method for assessing and analyzing the risks of adverse effects resulting from the use of at least one drug of interest for storing data regarding the risks of adverse effects from the use of at least one drug of interest in one or more servers linked to the Internet; updating such data regarding the risks with additional information pertinent to the risks of adverse effects from the use of the at least one drug of interest; permitting at least one remote user to access such data through the World Wide Web upon proper authentication; permitting the at least one remote user to identify the at least one drug of interest; permitting the at least one remote user to select data stored in the one or more servers relevant to the safety of using the at least one drug of interest; permitting the at least one remote user to analyze safety issues resulting from use of the at least one drug of interest, and permitting the at least one remote user to display such data and analysis.
The web based system described provides patients, government health agencies and physicians with details of drug-drug interactions, adverse effects, including non-responsiveness, and resistance. The system relates to some extent, to clinical, genetic and metabolic inputs. It provides alternative treatments.
It will be appreciated that the physician has limited time with patients and has to access relevant information as quickly and efficiently as possible. Improvements in drug prescription affect the quality of life for the patient and benefit society as a whole.
Despite the great steps forward with computer access to information, the physician's time is at a premium. There is an ongoing need for more effective treatments, cost savings to the health system and faster prescription of more appropriate drug regimes, whilst minimizing the risk of adverse interactions.
Embodiments of the present invention address these needs.